Why do I have a pain in my butt??!!

What do we treat the most at Missing Link Physical Therapy??!!!The pain in the butt!!! No, I don’t mean the client, but literally a pain in the butt sometimes referred to as sciatica or piriformis syndrome. Often individuals have difficulty standing, sitting, walking, running or going up stairs. This pain can be very debilitating and decrease function and quality of life. This blog is aimed to address ways to decrease pain and the necessary treatment required in order to regain your mobility and function.

Frequently when a sudden ache in the butt or leg occurs people always wonder, why? Individuals often don’t experience back pain and have not done anything differently to cause this pain. Well, the body is a great machine and was built to be resilient. Very often by the time you experience a particular pain the movement dysfunction has been present for years. It is like eating the wrong foods and years later you have hypertension and heart disease. In the majority of cases we can contribute the cause of the pain to a nerve irritation in the low back or peripheral muscles. For instance, with mild to moderate degrees of nerve irritation to the low back you can get this abnormal tightness and guarding of the hamstring, gluteal (butt) muscles, calf muscles and even heel pain or cramping of the bottom of the foot.

In order to start recovering from this state you need to remove the irritation to the spine. If the condition is acute this can be done by pharmacological means (please refer to your physician for the appropriate drug of choice). From a Physical Therapy disposition this can be done by avoiding certain postures; such as slouched positions, any activity that may place stretch on the hamstring (want to avoid stretching of the hamstring as it will cause stress on the nerve if there is nerve tension), reading in the bed with legs extended…Basically you want to avoid any position that will place stress on the nerve. Imagine a long string that is attached to your spine and extends all the way to your foot, every time you slouch or stretch the hamstring you irritate the nerve. The stretch may feel good initially but you will find that you may suffer a rebound effect of pain later in the day, with even more tightness in the particular muscle. Figure A shows an individual reaching into a box with a rounded back posture; this will increase tension in the back and also the nerve. Figure B shows an individual stretching the hamstring with a rounded back posture, at this time the nerve may be on maximal tension and irritation may be at its greatest. In Figure C the individual to the left is placing increased stress to the back and nerve, the individual to the right is exhibiting good technique with lifting by hinging from the waist and bending the knees.

poor lifting


hamstring stretch

Figure B


Figure C

After decreasing the nerve irritation it is now time to improve the muscle tension. This can be done by getting a deep tissue massage, foam rolling or trigger point dry needling (my recommended treatment of choice). You want to improve the muscle length of the gluteal muscles and back muscles. Figure D, E, F, H represent foam roll massages; these massages should be performed as tolerated, slowly kneading out the trigger points in the respective muscles. Figures G and I represent stretches that can be performed for approximately 45-60 seconds. Please refrain from doing exercises if pain is elicited.

Glute_Max 1

Figure D. Foam roll gluteals


Figure E. Foam roll TFL


Figure F. Foam roll low back. Be sure to keep back neutral or slightly flexed in order to avoid excessive stress on the low back.


Figure G. Piriformis stertch

foam roll QL

Figure H. Foam roll quadrates lumborum (side of back).

QL stretch

Figure I. Quadratus lumborum stretch (stretch to side of back)

Last step is to stabilize the spine by avoiding an anterior or posterior pelvic tilt. I recommend stabilization of the lumbar spine with the back in neutral.


Figure J. The picture to the left represents an anterior pelvic tilt. The picture in the middle represents a neutral spine. The picture to the right represents a posterior pelvic tilt.

In this blog I have purposely avoided educating on abdominal stabilization as I believe that the exercise for stabilization should be monitored. The reason individuals have pain in the first place is because of a movement dysfunction, so I highly suggest getting assistance from a trained movement specialist (physical therapist, personal trainer, athletic trainer, pilates instructor, yoga instructor etc.). Pain does not just appear but is comes about due to increased stress being placed on a structure in the body over time. REPAIR THE MOVEMENT AND YOU IMPROVE THE PAIN.

Please take note that in order to have somewhat of a full recovery from this injury you must make sure that you are able to contract the deep abdominals appropriately and work on maintaining the contraction over time with your respective exercise/activity. With practice over time these muscles should contract involuntarily.

Over time if symptoms appear to be unrelenting and worsening we suggest getting further diagnostic testing to determine if there is structural damage such as a disc bulge/ herniation, degenerative changes in the spine, etc. Further medical treatment may be required in order to decrease symptoms prior to initiating an exercise program.

In our clinic we see many of these cases and have been very successful with treatment. We shall be delighted if you call us and schedule an appointment today. I am sure that you want to resolve the nagging pain in your ‘butt’.

You can Contact us at: Phone:703-858-5070, Email: office@missinglinkpt.com, website:www.missinglinkpt.com.

We are located at: 44933 George Washington Blvd Suite 165, Ashburn VA 20147


Got knee Pain?? Here are some tips to help

Today we are discussing ways to improve pain located on the outer part of the knee. This pain is sometimes called runner’s knee, IT Band syndrome or just a pain in the knee :-). Pain may be present with going down steps, walking down hills, standing after prolonged sitting or by straightening your knee from a bent position.

Today I will provide a few remedies for this type of knee pain so that you can regain your mobility and decrease the amount of stress being placed on the knee. This type of knee pain is caused by hip muscle tightness and weakness in the majority of cases.

The first intervention required to decrease the knee pain is to loosen the hip muscles. How do we do this? Deep tissue massage to the hip muscles is the best way as stretching only gets the superficial layer of the muscle.


A. Foam rolling quadriceps and tensor fascia latae.

Glute_Max 1

B. Foam rolling hip muscles. This is the preferred stretch for the hip muscles if pain is acute.

glute rollout

C. Foam roll stretch for hip muscles. By crossing the affected knee over the other knee you will be stretching the hip muscle in conjunction to the massage. This may be too aggressive if pain is acute. If so please perform foam roll exercise in diagram B.

After massaging the muscle in order to get blood flow to the area and to assist in improving muscle length I recommend stretching the muscle. Below are some examples of suggested stretches.


A. Quadriceps stretch. Hold for 45 seconds 3-4 times. Better to perform after muscles are warm.


B. Hip stretch:Hold for 45 seconds 3-4 times. Better to perform after muscles are warm.


C. Hip stretch:Hold for 45 seconds 3-4 times. Better to perform after muscles are warm.

After regaining your mobility you should begin pain free strength training. By strengthening the hip you can decrease the risk of the muscle tightening up again. It is important to understand that if you return to stressful activity prior to being strong enough, the tightness to the hip and the knee pain will return. You must restore the mobility and stability of the injured leg in order to avoid re-injury.


A1. Clamming: This is the starting position of the clamming exercise. The top foot stays placed on the bottom knee. This exercise is focused on strengthening the hip. The back and pelvis is to stay straight during performance of the exercise.


A2. This is the finishing action of the clam. Top foot stays on bottom knee and the back and pelvic stay straight. Repeat 30 times.


B. Quadruped alternating leg: With the hands under your shoulder and knees under hips maintain a straight spine. Slowly extend one leg while maintaining a neutral spine. This will assist in hip and abdominal stabilization. Repeat 10-15 times each side.


C. With a stick, place it along your spine maintaing the contact points of the back of the head, middle of upper back and buttocks. Slowly slide the non affected leg back followed by hinging of the trunk maintaining the 3 points of the stick. Then slowly return to an upright position. Repeat 10-15 times each leg.

These are just a few tips in order to assist in decreasing pain, improving range of motion and strength. Further manual therapy may be required in order to solve the underlying issue for the long-term.